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Semin Thromb Hemost 2011; 37(3): 209-219
DOI: 10.1055/s-0031-1273085
© Thieme Medical Publishers

Multiple Myeloma, Venous Thromboembolism, and Treatment-Related Risk of Thrombosis

Elena Zamagni1 , Annamaria Brioli1 , Paola Tacchetti1 , Beatrice Zannetti1 , Lucia Pantani1 , Michele Cavo1
  • 1“Istituto di Ematologia “Seràgnoli,” Università degli Studi di Bologna, Bologna, Italy
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Publication History

Publication Date:
31 March 2011 (online)

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ABSTRACT

Venous thromboembolism (VTE) is a disease with a high prevalence in elderly people, affecting > 5% of the population > 65 years of age. Cancer patients have a 4.3-fold higher incidence of thrombotic complications, due to multiple risk factors that are not always related to the disease. Among hematologic malignancies, multiple myeloma (MM) confers a high risk of developing such complications, with a VTE rate of nearly 10%. Multiple factors are involved in MM-related VTE, such as increased blood viscosity, high levels of immunoglobulin, procoagulant activity of monoclonal protein, and inflammatory cytokines. Since the introduction of the immunomodulatory derivatives (IMiDs) thalidomide and lenalidomide in the therapeutic armamentarium of MM, VTE has emerged as one of the leading complications, in particular in patients with newly diagnosed MM. In this setting, IMiDs-based treatments are associated with rates of VTE reaching values up to 14 to 26%, particularly when dexamethasone or chemotherapy are added. The optimal prophylaxis for patients receiving these antiangiogenetic agents is still a matter of debate. Due to the lack of prospective randomized clinical trials, different studies have used various anticoagulant prophylaxes, including fixed low-dose warfarin (1 mg or 1.25 mg), therapeutic doses of warfarin (international normalized ratio between 2.0 and 3.0), low molecular weight heparin, or low-dose aspirin. As yet, no study has clearly demonstrated a significant superiority of one prophylactic regimen in comparison with the others. Further investigation and more randomized clinical trials are needed to define the best thromboprophylaxis.

KEYWORDS

Multiple myeloma (MM) - deep vein thrombosis (DVT) - thalidomide - lenalidomide - venous thromboembolism (VTE)

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Elena Zamagni

Istituto di Ematologia “Seràgnoli,” Università degli Studi di Bologna - Policlinico S. Orsola-Malpighi, Via Massarenti

9 – 40138 Bologna, Italy

Email: e.zamagni@unibo.it